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As part of the negotiations over the fiscal cliff, Congress and President Obama are battling over whether to raise marginal tax rates at the very top of the income ladder.

Regardless of how these talks turn out, millions of Americans are already facing tax hikes thanks to Obamacare.

Obamacare's authors chose to offset about half of the trillion-dollar cost of the law through higher taxes. Since the Supreme Court upheld the law's individual mandate and allowed states to opt out of its Medicaid expansion, though, the cost estimate has swelled to $1.76 trillion between 2012 and 2021.

In 2013, a number of Obamacare's taxes will go into effect. Each will increase the cost of health care, yield job losses, and deprive our struggling economy of investment. These are the true costs of Obamacare.

Let's look at some of these taxes individually.

On January 1, 2013, a 2.3-percent excise tax on the gross sales of medical-device companies -- regardless of whether they turn a profit or suffer a loss -- will take effect. The tax will hit everything they sell, from x-ray machines and pacemakers to surgical tools and artificial hips. The levy could extract as much as $29 billion over the next 10 years.

That money will have to come from somewhere; device firms won't simply swallow the tab. So they'll likely raise prices for patients and slash their workforces. In fact, economists at the Manhattan Institute project that the tax could eliminate as many as 43,000 jobs -- and over $3.5 billion in employee compensation.

The industry currently employs about 400,000 people and supports roughly 2 million manufacturing jobs. With unemployment -- particularly in the manufacturing sector -- still a national concern, it makes little sense to penalize device firms.

Because of the tax, medical-device firms will also have less money to invest in research and development. My colleague Benjamin Zycher estimates that the industry will scale back investment in new products by 10 percent through 2020. That translates to a $2-billion decrease per year.

House Republicans have been trying to repeal the tax for some time. In recent weeks, they've gotten some unlikely company -- from Senate Democrats.

This month, 16 Democrats from the upper chamber urged President Obama to delay the tax's implementation because of the risks it poses to the industry. In a statement, Sen. Al Franken (D-Minn.) described it as a "job-killing tax."

Even an 11-figure tax like the device levy will only cover a paltry share of Obamacare's total bill. A much larger portion is scheduled to come from higher taxes on top earners.

Individuals with annual incomes higher than $200,000 and couples who make more than $250,000 a year will face two new taxes -- a 0.9-percent increase in the 1.45-percent Medicare levy on earnings above those income thresholds and a new 3.8-percent tax on investment income. Together, these two taxes are expected to raise about $318 billion over the next decade -- roughly half of the law's new tax revenue.

The structure of these taxes penalizes married couples in particular. According to the New York Times, two unmarried singles who made $200,000 each would not owe any additional Medicare tax. But if they were married, they'd owe $1,350.

Meanwhile, the 3.8-percent tax on unearned income, like capital gains, dividends, and interest, will discourage saving and investment. That's the exact opposite of what Congress should be doing now, what with the economy still stalling.

Obamacare's tax hikes aren't just confined to the rich. The law raises the floor for the deduction of medical expenses, from 7.5 percent of income to 10 percent. So only expenses beyond 10 percent of a person's income will be deductible. This change could add hundreds of dollars to the tax bills of those struggling with major medical bills.

Obamacare also halves the maximum contribution to flexible spending accounts (FSAs), from $5,000 to $2,500. Many consumers use FSAs to cover routine medical expenses, like vision care, orthodontia, and prescription drugs. They won't have nearly as much money to work with in 2013.

By neutering FSAs, Obamacare deprives patients of control over their own health care -- and puts insurers and government in the driver's seat. Instead of paying for routine care with pre-tax dollars, individuals will have to purchase expensive insurance that covers routine care. In the end, patients may end up paying more.

These are just the five taxes scheduled to kick in next year. In 2014, another multibillion-dollar round of taxes will go into effect, including an excise tax on high-value insurance plans, a levy on health insurers, and the individual mandate's "tax" on people who remain uninsured.

The money to pay for Obamacare's healthcare overhaul, which will be in excess of $1 trillion and probably upwards of $2.5 trillion from 2014 to 2023, has to come from somewhere. In the New Year, Americans will find that "somewhere" is their wallets.

Sally C. Pipes is President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her latest book is The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare (Regnery 2012).